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These days there’s a lot of information—and misinformation—floating around about hyaluronic acid fillers. So, it’s only natural to feel a little nervous about booking your first appointment, especially when “pillow face” horror stories and photos of injections gone very, very wrong are all over TikTok.
But if you’re curious about filler, those cautionary tales needn’t scare you. In the hands of the right provider, filler can enhance and even transform your face with just a few strategic pokes. Still, that means finding a skilled provider is essential—and so is knowing what to ask before they inject you. “Filler requires more than one skill set to excel: medical knowledge of anatomy, sterile technique, and ability to work gently with tissue, as well as an aesthetic eye and attention to detail,” says Caren Campbell, MD, a board-certified dermatologist in San Francisco.
To Dr. Campbell’s point, getting filler may not take very long most of the time, but it’s still a medical procedure and should be taken seriously—which is where a consult comes in. Ideally, you see a qualified, board-certified dermatologist or plastic surgeon for the procedure. But even if you’re seeing another type of provider—say, at a med spa—a good practitioner should be more than happy to discuss all your concerns. “The industry works hard to sell [getting filler] as an easy, breezy, in-and-out enhancement, but at the end of the day, it’s a needle going into your body…. A consult is the best way to ensure you’re making an educated decision and getting all your questions answered,” Dr. Campbell says.
Not sure what to ask? Ahead, we’ve laid out some thought starters for your first filler appointment.
Meet the experts:
- Caren Campbell, MD, is a board-certified dermatologist in San Francisco.
- Dendy Engelman, MD, is a board-certified cosmetic dermatologist and Mohs surgeon in New York City.
- Brendan Camp, MD, is a double board-certified dermatologist and dermatopathologist in New York City and Long Island.
What are your credentials?
To ensure your safety and treatment quality, it’s best to see a board-certified dermatologist or plastic surgeon for hyaluronic acid filler injections. While filler is readily available at med spas and “injectable bars,” you want to be confident that you’re putting your face in the hands of an expert.
In Dr. Campbell’s view, injectors should be physicians from specialties “that perform surgery and a lot of medical procedures so they’ve got a deep understanding of anatomy to inject and potentially manage any complications from the procedures they’re performing,” says Dr. Campbell. “Unfortunately, given the aesthetic industry’s big push to ‘train’ more and more injectors with little to no expertise, there are lots of ‘providers’ performing medical procedures that should require years of training,” she continues.
Dr. Campbell’s thoughts align with Allure’s ongoing stance that any procedure that crosses the skin barrier should be performed with a board-certified dermatologist or plastic surgeon present—but this doesn’t always happen at med spas due to lax and inconsistent regulations that vary from state to state. For example, a 2023 study in Dermatologic Surgery found that of nearly 130 med spas reviewed in the greater Chicago area, more than 80% didn’t have a doctor on-site. Until med spas are better regulated, you’ll definitely want to proceed with caution and ask the right questions to ensure you’re working with a qualified professional.
No matter where you choose to seek care, watch out for red flags, like providers who “can’t clearly explain their credentials, treatment plan, or product choice,” says Dendy Engelman, MD, a board-certified cosmetic dermatologist and Mohs surgeon in New York City. “Be cautious if they don’t perform a full-face assessment or if they suggest excessive filler,” she adds. There’s no such thing as a one-size-fits-all approach to filler, so what constitutes “excessive” can vary from patient to patient, but if this is a concern for you, it’s a good idea to look for an injector with a lighter touch. Dr. Engelman recommends taking a peek at a provider’s website or social media to get an idea of their work before booking your visit—do the results look natural or overfilled? In addition, she recommends avoiding “clinics that don’t use FDA-approved products or fail to warn of all potential risks and aftercare.”
Why is hyaluronic acid the best type of filler to address my concerns?
Sure, you’ve probably heard a lot about dermal filler, but do you know the difference between hyaluronic acid (also called HA) filler and biostimulatory filler, or why you’d choose one over the other? The world of injectables is confusing and ever-changing, so don’t be afraid to ask what might feel like a “silly” question; trust us, it’s not silly!
Hyaluronic acid is a water-binding molecule that helps maintain skin hydration and elasticity, and it’s found naturally in the body. “As we age we naturally produce less collagen, so HA is a great way to bring back the appearance of plumper, more hydrated skin,” says Dr. Engelman. “When injected, HA restores lost volume, smooths fine lines, and supports the skin’s structural matrix,” she explains. You might use hyaluronic acid to add volume to “less mobile” areas like the temples and midface or to tweak your facial shape by altering the appearance of the nose, jawline, or lips.
Biostimulatory filler, on the other hand, helps boost collagen production, so the results become more noticeable over time, unlike the quick effects of an HA filler. It can be used in various places, including the cheeks and temples. Providers may also use it to improve the look of crepey skin on the arms, around the elbows, and on the upper knees.
Long story short, you want to ensure your provider is recommending the type of filler that will deliver the results you want. Asking them to explain the rationale behind their recommendation can help ensure you and your injector are on the same page.
Which filler are you injecting and why?
Popular brands like Juvéderm and Restylane make their fillers with hyaluronic acid, but that doesn’t necessarily mean each formula will give you the same result. Dr. Engelman recommends asking your provider which formula they recommend for your desired look and why they think it’s the right fit. What works well for teeny-tiny wrinkles may not be the best fit for the lips and vice versa. For example, Dr. Campbell likes using Juvéderm’s Voluma XC and Restylane’s Lyft in the cheeks and Restylane Defyne in the chin but notes that it’s more about the skill of your injector and their expertise than the brand name. “The painter needs to know how to mix the paint,” she says.
What results can I reasonably expect?
Hyaluronic acid filler can boost small or deflated lips, smooth wrinkles, add volume and plumpness, and even enhance skin texture, but it’s not a cure-all.
Brendan Camp, MD, a double board-certified dermatologist and dermatopathologist in New York City and Long Island, says patients sometimes think filler can do more than it actually can and your provider should help manage your expectations. “Fillers do not pull the skin up and back, which is what patients often do to their skin when looking at themselves in the mirror,” he notes. “Looking in the mirror with the patient together and giving them an idea of what fillers can accomplish is important to do before any filler procedure to set realistic expectations.”
Still, Dr. Campbell says, “we have lots of tools in our tool kit,” which means that there’s probably something to help achieve your desired look, even if it’s not hyaluronic acid filler. So don’t be afraid to ask about your options should your provider fail to suggest alternatives. Dr. Campbell uses an analogy with patients to explain how combining various treatments can give them the results they want: Your face is like a chair. “You have your wooden frame, your foam, and the upholstery. Ideally, you are addressing all layers in an effort to look your best,” she says. Dr. Campbell uses a biostimulatory filler like Sculptra as the “frame” and considers hyaluronic acid filler the “cushion,” providing soft volume. Finally, skin care, Botox, and other treatments such as lasers treat the “upholstery.” A quality provider should be able to offer a holistic view and a comprehensive plan to suit your needs and address your concerns.
When in doubt, bring photos to share with your doctor. These can serve as a good starting point for a transparent conversation about the results you can expect. “I always advise coming into your appointment and consultation with a clear vision of your aesthetic goals, ideally with photo references if you can,” says Dr. Engelman.
How do I avoid looking “overfilled”?
If that’s something you’re worried about, bring it up! Quality providers will be more than willing to explain what they recommend and why. Plus, one injector’s definition of “natural” may not be the same as another’s. (That’s why asking for before-and-after pictures from a provider’s previous patients is another important step before moving forward with treatment.)How should I prepare for my injection appointment?
Before coming back for injectables, it’s wise to ask your provider what you should do—or avoid doing—beforehand. For example, Dr. Camp tells his patients to steer clear of alcohol the night before getting filler, and to stop taking aspirin and certain supplements (such as fish oil) a week before. All of these things can have a blood-thinning effect that can worsen bruising. He also advises patients with a history of cold sores to consider taking an antiviral medication (either a prescription drug such as valacyclovir or an over-the-counter option like Abreva) before their filler appointment to help ward off flare-ups triggered by injections near the mouth. Additionally, Dr. Engelman recommends showing up sans makeup to reduce the risk of infection. It’s definitely worth asking your provider if they have any similar recommendations for you.
How will you minimize pain during the injections?
Filler can be a bit painful, both in the moment and for a short time after, though many filler products contain lidocaine to help numb the treated area. Doctors have different preferences when it comes to pain-management techniques, so it’s never a bad idea to ask your provider about their approach. For example, Dr. Campbell likes to give patients stress balls and play relaxing music in addition to applying pre-injection numbing cream to minimize pain.
What should I know about post-injection care and avoiding potential side effects?
Hyaluronic acid filler is generally very safe, provided you’re working with an experienced professional, says Dr. Engelman. Before you head home, though, it’s smart to ask your injector about what side effects are and are not a cause for concern, and how they suggest treating the most common issues that tend to crop up. You may encounter some mild after effects, including “temporary swelling, redness, tenderness, or bruising at the injection site.” Ice packs or a cold compress can help relieve some of these issues.
As for post-injection care, if you’re a regular exerciser, your provider may recommend that you get your workout in before your appointment, rather than after. Vigorous exercise, as well as steam rooms and saunas, can sometimes cause bruising or filler migration, Dr. Camp explains. You can typically resume normal activities after 24 to 48 hours; however, it’s best to consult with your injector to confirm.
How do I know if I’m experiencing side effects from the filler, and what is your plan in the event of an emergency?
Before injecting you with anything, a good provider should be able to outline how they’d help if you experience a complication. They should also explain the symptoms to watch for, like severe pain or skin-color changes, that warrant calling them or going to the emergency room.
For example, whitening of the skin, dusky discoloration, or blotchy red, purple, dark brown, or grey patches near the injection site may be a sign of compromised blood flow, which requires immediate medical attention. Symptoms like sudden vision changes, persistent swelling or redness, and lumps that last longer than a few days may indicate that you’re experiencing side effects such as vascular issues, an infection, or an inflammatory reaction to the filler. Less common side effects include long-lasting lumps and asymmetry. Vascular complications can also occur if the filler is placed incorrectly. Since complications can quickly become medical emergencies, it’s good to know how your provider plans to care for you should that happen before you get any injections.
How long does hyaluronic acid filler last?
You may not want your filler to look super obvious, but you probably want the results to last. Longevity depends on the type of filler you get and where it’s placed, though most HA fillers generally last anywhere from a few months to a year. Ask your injector what you can expect.
What happens if I’m unhappy with my results?
If you do wind up feeling meh about your results, there’s a good chance your provider will tell you not to jump to conclusions and take a beat. It can take up to four weeks for the swelling to subside and the filler to settle.
That said, you might find it comforting to know that hyaluronic acid filler can be dissolved with the enzyme hyaluronidase, which Dr. Engelman says can break down the substance within hours (though it may take longer). “This reversibility offers reassurance that results aren’t permanent,” Dr. Engelman says.
However, patients should still place their trust in an experienced provider who knows how to address any issues, so definitely ask the practice how it handles these situations. Will your provider try to finesse the filler or dissolve it? Are corrections free, or do they charge a fee? If there is a fee, how much is it? These are important things to know before getting an injectable.
Although it can feel intimidating at first, arriving at your injection consultation with a few thoughtful questions prepared can be a game changer for easing any nerves and making you feel more confident in your decision.
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